A Study of the Effectiveness of SMOF Lipid Infusion in the Management of Acute Clozapine Poisoning

Khalil, Nancy Osama; Sheta, Abeer Abd El-Moneim; Madkour, Somaya Abdel-gawad; Zaytoun, Tayseer Mohamed; Mohamed, Omneya Ibrahim

doi:10.21608/esctj.2025.381156.1089

A Study of the Effectiveness of SMOF Lipid Infusion in the Management of Acute Clozapine Poisoning

Document Type : Original Article

Authors

¹ Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

² Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Egypt.

³ Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

10.21608/esctj.2025.381156.1089

Abstract

Background: Clozapine is a frequently prescribed atypical antipsychotic medication. Profound sedation, tachycardia, and hypotension are common symptoms. Due to the lack of antidotes, standard supportive treatment could be enhanced with promising agents like Intravenous Lipid Emulsions (ILE), which effectively manage lipophilic agents’ toxicity. Aim of the work: Verifying the effectiveness of SMOF lipid infusion in managing acute clozapine poisoning. Subjects and methods: Forty patients suffering from moderate or severe acute clozapine poisoning were randomly selected and assigned to two equal study groups. The first group (the control group) received only the standard treatments, while the second group (the intervention group) received the SMOF Lipid 20% infusion in addition to the standard therapy. Each patient underwent a thorough review of their medical history, clinical examinations, and laboratory investigations. The outcomes of the study were evaluated. Results: Regarding the mean Glasgow Coma Scale (GCS), it was (11.50±2.89 vs 7.55±2.06, p<0.001) at 6 hours and (13.45±2.14 vs 8.55±3.09, p<0.001) at 12 hours post-admission, showing significantly better results among patients in the intervention group. Moreover, the intervention group experienced a significantly lower occurrence of complications, including aspiration pneumonia and cardiovascular issues (p=0.047), fewer patients requiring mechanical ventilation (MV) (p=0.038), and a significantly shorter duration of hospital stay (p<0.001). Conclusion: This study revealed that SMOF lipid infusion improved GCS, reduced the need for MV, lowered the incidence of complications, and shortened the duration of hospital stay. No side effects were reported with SMOF lipid administration.

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